Cerebro–costo–mandibular syndrome: Clinical, radiological, and genetic findings

Madeleine Tooley, Danielle Lynch, Francois Bernier, Jillian Parboosingh, Elizabeth Bhoj, Elaine Zackai, Alistair Calder, Nobue Itasaki, Emma Wakeling, Richard Scott, Melissa Lees, Jill Clayton-Smith, Sarah Smithson

Research output: Contribution to journalArticle (Academic Journal)peer-review

20 Citations (Scopus)


Cerebro–Costo–Mandibular syndrome (CCMS) is a rare autosomal dominant condition comprising branchial arch-derivative malformations with striking rib-gaps. Affected patients often have respiratory difficulties, associated with upper airway obstruction, reduced thoracic capacity, and scoliosis. We describe a series of 12 sporadic and 4 familial patients including 13 infants/children and 3 adults. Severe micrognathia and reduced numbers of ribs with gaps are consistent findings. Cleft palate, feeding difficulties, respiratory distress, tracheostomy requirement, and scoliosis are common. Additional malformations such as horseshoe kidney, hypospadias, and septal heart defect may occur. Microcephaly and significant developmental delay are present in a small minority of patients. Key radiological findings are of a narrow thorax, multiple posterior rib gaps and abnormal costo-transverse articulation. A novel finding in 2 patients is bilateral accessory ossicles arising from the hyoid bone. Recently, specific mutations in SNRPB, which encodes components of the major spliceosome, have been found to cause CCMS. These mutations cluster in an alternatively spliced regulatory exon and result in altered SNRPB expression. DNA was available from 14 patients and SNRPB mutations were identified in 12 (4 previously reported). Eleven had recurrent mutations previously described in patients with CCMS and one had a novel mutation in the alternative exon. These results confirm the specificity of SNRPB mutations in CCMS and provide further evidence for the role of spliceosomal proteins in craniofacial and thoracic development.
Original languageEnglish
Pages (from-to)1115-1126
Number of pages12
JournalAmerican Journal of Medical Genetics, Part A
Issue number5
Early online date12 Mar 2016
Publication statusPublished - May 2016


  • Cerebro–costo–mandibular syndrome
  • CCM syndrome
  • rib gaps
  • micrognathia
  • Pierre Robin syndrome


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